The Duke-UNC Comprehensive Sickle Cell Center is a widely based facility for the promotion of research, improved care, and education for patients with sickle cell disease, their families and their community. The Center is based at three universities (Duke, the University of North Carolina at Chapel Hill, and East Carolina University and at two Community Centers (Triad Sickle Cell Foundation at Greensboro and Operation Sickle Cell at Fayetteville). The theme of the Center is "Algorithms for Improved Care" and the research efforts are primarily directed to a better understanding of the basic science, the clinical, the psychosocial, the care delivery, and the health policy and ethical aspects of the disease. A new Division of Policy and Ethics will consider broad questions of sickle cell disease in the context of society. In the Division of Basic Science Research, the control of the expression of the globin genes, the alterations in membrane transport of the red cell, and the role of coagulation in vaso- occlusive phenomena will be investigated. In the Division of Clinical Research, a large population of patients will be supported so that they may take part in investigations of the renal and pulmonary dysfunction in sickle cell disease, the correlation of rheological measurements with clinical state, the use of hydroxyurea in children, the analysis of the nutritional changes that occur with hydroxyurea treatment as well as many other clinical studies not directly funded. The very successful Division of Psychosocial Research will continue its study of self-help groups, of coping strategies and of the possible changes that might alter school performance. The Division of Education will support the educational efforts of the Center as well as the state and other Centers; the investigation of the use of lay volunteers in the spread of knowledge about sickle cell will be continued. The Community Clinics will support other clinical research efforts as well as investigate the role of home health care in the management of sickle cell disease. The statistical and data management aspects of the Center will be maintained by a new Biometry Core.